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Ophthalmol Case Rep 2017 Volume 1 Issue 1
August 21-23, 2017 | Toronto, Canada
EYE AND VISION
3
rd
International Conference on
Introduction:
Vitreoretinal surgery has far advanced
since the last decades, coming to a modern area of both
vitrectomy and viewing systems, as well as with better
approaches from the retinal surgeon, with the use of smaller
gauge instruments, making the procedure easier to perform,
thus contributing to a better follow up and recovery from the
surgery. Though repairing techniques have changed, scleral
buckling techniques are still popular since Charles Schepen’s
techniques in the early 1950s. Combined approaches are
still largely employed, increasing the likelihood of attaching
the retina, such as pars plana vitrectomy and scleral
buckling procedures, with laser or cryotherapy, the last
one mentioned less used due to disadvantages involving
retinal pigment epithelium spreading and proliferative
vitreoretinopathy, but not counter indicated though. Even
though the cost and equipment involving vitrectomies are
higher than those of scleral buckling alone, the anatomical
results are proved to be faster with both approaches rather
than with just one. Scleral buckling techniques, even though
used in a lesser extent, still have the indication especially in
the phakic patient. For the pseudophakic or aphakic patient,
some buckle techniques or modified and combined buckle
and vitrectomy techniques are used, such as using a band
together with vitrectomy to help increase the likelihood
the retina will attach during and after the procedure is
made. Vitreoretinal surgery used to take too long before
the development of wide angle vitrectomy viewing systems.
Before it, prisms lenses had to be rotated for the aim of
viewing the far periphery, and the contact lens often had
to be held with a ring on the cornea. With the advent of
23-gauge vitrectomy, 25 and 27 came afterwards and are
far more used nowadays, and benefits are linked to better
success rates. Intraoperative Optical Coherence Tomography
assisted vitrectomies, despite expensive, are helping treat
macular diseases as well as other vitreoretinopathies, giving
a simultaneous visualisation of the procedure of the actual
surgical record comparing with the topographical cut making
it more accurate to approach the retina and expecting
better outcomes. Magnifying lenses and inverting image
systems are applied in the management of manage macular
diseases such as macular holes, epiretinal membranes and
others such as proliferative vitreoretinopathy. The use of gas
or silicon oils increased overtime, as well as fluorocarbon
liquids, playing a very important role not only in repairing
retinal detachments, but also helping the surgeon control
better hard and demanding cases.
Conclusions:
We conclude that such a combined approach
to primary pseudophakic and aphakic retinal detachments
offers significant benefits to scleral buckling alone. We
believe that the improved success rate is a function of
vitrectomy contributing to both an improved peripheral
visibility, resulting in fewer missed peripheral breaks, and
a lower likelihood of proliferative vitreoretinopathy. We
recommend this combined surgical approach for all primary
pseudophakic and aphakic retinal detachments. We conclude
that such a combined approach to primary pseudophakic
and aphakic retinal detachments offers significant benefits
to scleral buckling alone. We believe that the improved
success rate is a function of vitrectomy contributing to both
an improved peripheral visibility, resulting in fewer missed
peripheral breaks, and a lower likelihood of proliferative
vitreoretinopathy. We recommend this combined surgical
approach for all primary pseudophakic and aphakic retinal
detachments. Also, smaller gauge vitrectomies and wide-
angle vitrectomy viewing systems help manage tough
cases with less time and better outcome, making it feasible
and more cost effective in today’s vitreoretinal surgery
techniques.
Speaker Biography
Hudson Nakamura is a Medical Specialist in Ophthalmology and specialized in Retina
and Vitreous. He completed his study from School of Medicine at the Federal University
of Goiás – UFG and Residency from the Base Hospital of the Federal District - Brasília
- DF. Presently, member of American Academy of Ophthalmology, Brazilian Council of
Ophthalmology, Canadian Society of Ophthalmology and also the member of most
prestigious society ARVO - The Association for Research in Vision and Ophthalmology
United States. He works as a Professor in Department of Retina and Vitreous Course
of Medical Residency in Ophthalmology at the Bank of Goias Eye Foundation. He also
works as Specialist in vitreoretinal disease Fellowship - University of Toronto Canada,
Specialist in Ophthalmology - University of Toronto Canada, Specialist in vitreoretinal
disease Fellowship - Brazilian Centre for Eye Surgery.
e:
Hudson@nakamura.comModern vitreoretinal surgery and new trends in the treatment of retinal disorders
Hudson de Carvalho Nakamura
Goias Bank of Eyes Foundation, Brazil